Circulation. 2001;104:2689-2693
doi: 10.1161/hc4701.099789
doi: 10.1161/hc4701.099789
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(Circulation. 2001;104:2689.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Incidence, Predictors, and Significance of Abnormal Cardiac Enzyme Rise in Patients Treated With Bypass Surgery in the Arterial Revascularization Therapies Study (ARTS)
From the University Hospital Dijkzigt (M.AC., D.P.F., P.W.S.), Thoraxcentrum, Rotterdam, the Netherlands; the University of Florida (M.A.C.), Shands Jacksonville; St Paul’s Hospital (R.G.C., S.V.L.), Vancouver, Canada; Cardialysis BV (V.d.V., W.L.), Rotterdam, the Netherlands; the Medical Center De Klokkenberg (P.C.H.R., T.R.v.G.), Breda, the Netherlands; Hospital Clinico San Carlos (C.M., J.L.C.), Madrid, Spain; Hospital Universitario de Valladolid (F.F.-A., J.H.G.), Spain; and Landeskrankenanstalten Salzburg (G.H., F.U.), Salzburg, Austria.
Correspondence to Prof P.W. Serruys, MD, PhD, Head of the Interventional Cardiology Dept, Heartcenter/Erasmus University Rotterdam, Thoraxcenter, Bd-408, Dr Molewaterplein 40-3015 GD, Rotterdam, the Netherlands. E-mail serruys{at}card.azr.nl
Background— Although it has been suggested that elevation of CK-MB after percutaneous coronary intervention is associated with adverse clinical outcomes, limited data are available in the setting of coronary bypass grafting. The aim of the present study was to determine the incidence, predictors, and prognostic significance of CK-MB elevation following multivessel coronary bypass grafting (CABG).
Methods and Results— The population comprises 496 patients with multivessel coronary disease assigned to CABG in the Arterial Revascularization Therapies Study (ARTS). CK-MB was prospectively measured at 6, 12, and 18 hours after the procedure. Thirty-day and 1-year clinical follow-up were performed. Abnormal CK-MB elevation occurred in 61.9% of the patients. Patients with increased cardiac-enzyme levels after CABG were at increased risk of both death and repeat myocardial infarction within the first 30 days (P=0.001). CK-MB elevation was also independently related to late adverse outcome (P=0.009, OR=0.64).
Conclusions— Increased concentrations of CK-MB, which are often dismissed as inconsequential in the setting of multivessel CABG, appear to occur very frequently and are associated with a significant increase in both repeat myocardial infarction and death beyond the immediate perioperative period.
Key Words: cardiopulmonary bypass • creatine kinase • coronary disease
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